INTRODUCTION Laparoscopic cholecystectomy has revolutionized the treatment of gallstone disease, being the most remarkable surgical innovations of 20th century. As all other surgical interventions, laparoscopic cholecystectomy is also associated with number of complications, which may range from mild to serious and even life threatening at times. To prevent such complications routine drainage was adopted in laparoscopic cholecystectomy because of the fear of collection of bile or blood, requiring open procedures and to allow carbon dioxide insufated during laparoscopy to escape via the drain site, thereby decreasing the shoulder pain. On the other hand, drain use may increase infective complications and delay discharge. This serves as a basis to undertake present study to compare the effect of drain versus no drain use on outcome of laparoscopic cholecystectomy. MATERIALS AND METHODOLOGY The study was conducted at the department of General Surgery by senior faculties, at publicly funded tertiary care institution. 50 patients with symptomatic gallstone disease were admitted for elective surgery from October 2016 to October 2018. After obtaining Writtten informed consent, the patients were divided into two groups- Group A and Group B on random basis, Group A: (n= 25) Sub-hepatic space was drained by an abdominal drain (Ryle's tube No. 20) which was brought out through mid axillary port. Group B: (n= 25) Non-drainage of Sub-hepatic space All patients were subjected to Laparoscopic cholecystectomy under General anesthesia. Laparoscopic cholecystectomy was performed using three port or four port technique. In 25 patients in group B non-drainage of sub-hepatic space was used, in the group A sub-hepatic space was drained by a abdominal drain (Ryle's tube No. 20) which was brought out through mid axillary port. All the patients in both experimental and control group were evaluated for outcome measures postoperatively including Abdominal pain (Visual Analogue Scale), Shoulder pain, Drain site infection, Wound infection, Fever, Duration of post-operative hospital stay, Nausea, Vomiting, Hemorrhage. RESULTS AND DISCUSSION Ÿ In the present study symptomatology distribution of patients shows RHC pain most common symptom followed by Nausea / Vomiting in both drain and no drain group. Minor symptoms are epigastric pain, fever and right shoulder pain. Ÿ Both groups are homogenous in term of symptoms (p = 0.7013) Ÿ In present study, 15 patients with intra-operative adhesions need for drain kept while 4 patients with intra- operative adhesions did not need for drain kept. Ÿ In laparoscopic cholecystectomy, intra-operative adhesions increase need for drain kept and this difference is statically signicant. (p value= 0.0002) Ÿ In present study, 3 patients have normal calot's triangle absent, in which 2 have mirizzi syndrome and one patient have absent cystic duct. In all three patients drain kept. Out of three patients, one patient had biliary leak occurred in post-operative period and manage conservatively, and remaining 2 patient had only drain site pain occurred. Ÿ But in present study, need for drain in abnormal calot's triangle patients is statistically insignicant (p value= 0.074). This may be due to small sample size. Ÿ Laparoscopic cholecystectomy with drain took slightly more time than laparoscopic cholecystectomy without drain but this difference was statistically signicant.(p value=0.0001) Ÿ Consequently, more operative time requirement in drain thgroup may be due to anterior axillary 4 port insertion and keeping the drain. A COMPARATIVE STUDY OF ROLE OF DRAIN IN LAPROSCOPIC CHOLECYSTECTOMY IN CASES OF CALCULAS CHOLECYSTITIS Original Research Paper Dr. Jayesh V. Parikh HOU and Professor, Department of General Surgery, B.J. Medical College, Civil Hospital, Ahmedabad. General Surgery Laparoscopic cholecystectomy has become the gold standard treatment for gall stone disease. This procedure is also associated with difculties and complications. So, many surgeons adopted drainage of GB fossa after procedure to drain bile or blood to check for injury to CBD or vessels, which is protective. Putting a drain is also associated with post Op pain, longer hospital stay. This study is about merits and demerits of putting a drain in GB fossa of 50 patients undergoing elective laparoscopic cholecystectomy. ABSTRACT KEYWORDS : Laparoscopic Cholecystectomy; Calculus Cholecystitis Dr. Parth R. Dalal Assistant Professor, Department of General Surgery, B.J. Medical College, Civil Hospital, Ahmedabad. Dr. Vasant T. Padhiyar* rd 3 Year Resident, Department of General Surgery, B.J. Medical College, Civil Hospital, Ahmedabad. *Corresponding Author VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Symptoms No. of patients with drains (n=25) No. of patients without drains (n=25) RHC pain 24 24 Epigastric pain 7 10 Nausea / Vomiting 20 18 Fever 7 4 Right shoulder pain 0 0 Intra-operative Adhesions Normal Calot's Traingle Intra- operative Duration Present Absent Present Absent Average Duration No. of patients with drains (n=25) 15 10 22 3 106.8± 11.44min No. of patients without drains (n=25) 4 21 25 0 79.6± 15.13min 12 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Ÿ Incidence of post-operative pain is more in patients with drain group (Average pain score 6.6) as compared to no drain group (Average pain score 3.8) and this value is statistical signicant (p value = 0.0001). Ÿ The study of Sharma et al found similar ndings that patients with drain group had higher pain score (Average pain score 5.41) as compared to no drain group (Average pain score 3.45) with p value = 0.005. Ÿ In present study, without drain group most (76%) of patients were discharged within 3 days of operation while in with drain group most (76%) of patients were required post-operative hospital stay 4-7 days and 16% of patients were more than 7 days. CONCLUSION In this study, results indicate that routine drainage of gallbladder bed after elective laparoscopic cholecystectomy cannot be benecial. Drainage causes more postoperative pain, prolongs the operative time, increase drain site pain and infection, wound infection and prolongs the hospital stay. However, in selected patients with potential bile leak e.g. imperfect closure of cystic duct, bile staining of liver bed suggesting the possibility of missed accessory duct, difcult cholecystectomy due to inamed gallbladder and/or adhesions, abnormal calot's triangle, drainage can be benecial. At the same time drainage shouldn't be done only for the false sense of security as it can neither prevent postoperative biliary peritonitis nor bleed, unless great care is taken during surgery. Difcult laparoscopic cholecystectomy can be judge by pre- operative criteria of high WBC count, palpable gall bladder, previous attack of acute cholecystitis, previous abdominal surgery and USG ndings of thickened gallbladder wall, impacted stone at neck and pericholecytic collection and intra-operative criteria of inamed gallbladder, intra- peritoneal and peri-GB adhesions, structural anomalies and abnormal calot's triangle. Patients with absent of such criteria's can be operated with three port laparoscopic cholecystectomy, without drain and can be discharged within 24-48 hours. Final conclusion can be drawn by doing this study for operation done by experience senior surgeon, larger sample size and longer follow-up. REFERENCES 1) Evolution of cholecystectomy: A tribute to Carl August Langenbuch. Indian Journal of Surgery 2004;66:97-100. 2) Textbook of clinical embryology by Vishram Singh, 1st edition, page no. 165. 3) Bailey and Love short practice of surgery 25th Edition chapter 63 4) Gray’s anatomy, 39th edition, page no. 243-245. 5) Singh V, Trikha B, Nain CK, Singh K, Bose SM. Epidemiology of gallstone disease in india: A community-based study. Journal of Gastroenterology 2001; 16: 560-563. 6) Laparoscopic cholecystectomy an evidence based guide by ferdinando agresta, 1st edition, page no. 23,24. 7) Laparoscopic surgery of the abdomen By Bruce V. MacFadyen, 1st edition, chapter 15, page no.127 8) Maingot ’s abdominal operat ions 11th edi t ion, laparoscopic cholecystectomy, pg: 859 9) Mastery of surgery, 5th edition, chapter 97 10) ABC of Tube, Drain, Line and Frame by Wiley-Blackwell, 1st volume, chapter 8, page no. 44 11) Gupta A, Shrivastava UK, Kumar P, Burman D. Mini laparoscopic versus laparoscopic cholecystectomy: A randomized controlled trial. J Tropical Gastroenterology 2005; 26 (3): 149-151 12) KATHMANDU UNIVERSITY MEDICAL JOURNAL VOL. 14 | NO. 1 | ISSUE 53 | JAN-MAR 2016 Sharma A, Gupta SN: Drainage versus no Drainage after Elective Laparoscopic Cholecystectomy VOLUME-8, ISSUE-11, NOVEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Post-operative Pain Post-operative Hospital stay Mild Moderate Severe 1-3 days 4-7 days >7 days No. of patients with drains (n=25) 0 20 5 2 19 4 No. of patients without drains (n=25) 9 16 0 19 6 0 X 13GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS